Have we become a nation of energy-boosting addicts? Sure, most of us drink caffeinated coffee to get a little lift, but now we’re spending more than $12.5 billion a year on energy drinks, shots, and drink mixes — 60 percent more than we spent in 2008. No wonder energy drink makers are so eager to keep their products on shelves despite wrongful death lawsuits and harsh warning letters from federal health officials, members of Congress, and consumer watchdog groups.

Last Thursday the US Food and Drug Administration issued a harsh warning against energy drinks and supplements containing the stimulant dimethylamylamine (DMAA), telling consumers to stay away from it while adding that the agency was “using all available tools at its disposal” to ensure that it’s no longer sold. The agency was prompted by 60 reports of serious conditions such as heart attacks, seizures, psychiatric problems, and deaths associated with DMAA use.

“FDA has warned companies known to be using DMAA in dietary supplements that those products containing this ingredient are illegal,” it said on its website. That’s because the agency considers DMAA a new dietary supplement that needs to be tested for safety before it can be approved as an additive. The FDA said the ingredient is particularly dangerous when combined with caffeine, in products such as Jack3d.

Advertisement

But DMAA is just the tip of the iceberg: Emergency room visits related to energy drinks doubled from 10,000 to 20,000 between 2007 and 2011, often because of heart problems linked to a caffeine overdose. Those at biggest risk? Teens and young adults who are targets of marketing efforts by energy drink makers, according to a federal investigation released Wednesday by Massachusetts Representative Edward Markey and two US senators.

Get The Weekender in your inbox:

The Globe's top picks for what to see and do each weekend, in Boston and beyond.

“It’s time for energy drink makers to stop masking their ingredients, stop marketing to kids, and start being more transparent with their products,” Markey, a US Senate candidate, said in a statement. “It’s time for the FDA to crack down on these drink makers.”

More than one-third of teens consume energy drinks, according to the American Academy of Pediatrics, which recently warned pediatricians to urge their patients not to use these products because they contain unknown and unregulated amounts of caffeine and other stimulants that raise the risk of heart palpitations, insomnia, and dehydration.

The congressional report found that energy drink manufacturers determine whether to call their drinks beverages or dietary supplements.
There are different rules for what each can contain and what must be disclosed on the label. Energy drink beverages can’t include any ingredients that aren’t “generally recognized as safe” by the FDA for foods; beverage manufacturers do not need to disclose how much caffeine is in their drinks. Neither do they have to
file a report with the FDA if someone has a serious side effect from their products.

Energy drink supplements, on the other hand, have a different label that must list the amount of caffeine — unless it’s in a mix of proprietary ingredients. They can also contain a wide range of other ingredients such as herbs and amino acids without proof of being safe, as long as they were used in supplements before a 1994 federal supplement law was enacted.

Advertisement

Unlike beverage makers, supplement manufacturers must alert the FDA if they receive reports of side effects from their product.

Are you getting all of this?

It’s ridiculously confusing and the FDA has been trying for four years to clearly draw the line between energy beverages and liquid energy dietary supplements. Agency officials still haven’t come up with a solution. And they can’t get DMAA off the market without what the agency called “lengthy scientific and legal steps.”

Dr. Pieter Cohen, an internist at the Cambridge Health Alliance and assistant professor at Harvard Medical School, compared DMAA to an amphetamine and called for a ban on it last year in a research letter in the Archives of Internal Medicine.

“Patients tell me it pumps them up, gets them to work out better, maybe lose a little weight,” Cohen said. “But they get addicted to the caffeine and other stimulants and get headaches if they stop using it for a day.”

Advertisement

Until DMAA can be taken off the market, the FDA urged consumers to read energy drink labels and avoid any containing the ingredient.